Ventricular extrasystoles. Just an ugly electrocardiogram or a threatening burden?

03 Sep 2013

Assoc. Prof. Laszlo Saghy

Topic(s):

Arrhythmias

They are thought to be benign in apparently normal hearts, but as Etienne Aliot pointed out, some of these patients subsequently develop left ventricular (LV) dysfunction. There is no clear cut-off PVC frequency that can predict the development of LV dysfunction, but it is definitely more common above 24% of total beats during a day. PVC morphology, duration, coupling intervals, interpolation, and presence of retrograde P-waves can have some additive predictive values, but may not apply to all patients.

The mechanism of PVC-induced cardiomyopathy is not completely understood, and increased sympathetic activity, elevated pulmonary wedge pressure, and mechanical dyssychrony can play a role in worsening haemodynamic performance. The cause-effect relationship between PVCs and low EF can only be confirmed retrospectively, based on the presence or absence of other ethiologic factors and the long term reponse to medical or ablation therapy.

Karl-Heinz Kuck corroborated the fact that the majority of patients with PVCs have a benign course, with low risk of sudden death.

However, very rarely, these patients present with a malignant form of PVCs/VT, but only few data are available to prospectively identify patients at risk. A short PVC coupling interval (R on T), nsVT with short cycle length, and involvement of the Purkinje-system indicates a potential chance to induce malignant rhythm.

Stephan Willems presented the therapeutic options of PVCs. Drug therapy should be reserved for mainly acute settings, catheter ablation is recommended in symptomatic patients. Ablation procedures can be challenging, because of the anatomical complexities, but highly successful (>80%), resulting in constant supression of foci, and, occasionally, reversal of PVC-induced cardiomyopathy.

During the final part of the session, Luigi Di Biase demonstrated the hampering potential of PVCs on the effect of cardiac resynchronisation therapy via the loss of constant biventricular capture. Citing the results of their prospective, multicenter trial, he reported that after successful elimination of PVCs, the desired percentage of biventricular pacing was restored, promoting the improvement of functional status and LV reverse remodelling.

References

Session Title: Ventricular extrasystoles. Just an ugly electrocardiogram or a threatening burden?

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.